Does the new designation make it harder to get a key treatment covered?

The national guidelines for doctors and other clinicians was updated last year. DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, put out by the American Psychiatric Association.

In DSM-5, there is a new category in the autism spectrum — social communication disorder, or SCD. Since there are no clinical guidelines for treating SCD, autism advocates worry the new designation could be used by insurance companies to stop covering applied behavior analysis (ABA therapy) in treating autism disorder.

“It’s likely a small percentage [of SCD children among those with autism spectrum disorder], but it definitely will affect some people,” said Karen Fessel, director of the Autism Health Insurance Project. “There are no guidelines put out by insurance companies yet, so likely there will be no adjustments till October this year.”

The secondary concern for autistic children may be coverage in the regional centers, Fessel said. “[SCD] won’t be a qualifying condition in regional centers,” Fessel said. “And they have cut back in the past. Before 2009, people were getting a lot more coverage.”

Many conference attendees also will have another timely topic on their minds: State Senate President Pro Tempore Darrell Steinberg (D-Sacramento) scheduled an informational hearing before the Senate Select Committee on Autism & Related Disorders next week to examine the state’s oversight of Steinberg’s autism bill, SB 946, which was signed into law in 2011.

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California faces health care challenges seen across the country. At a time of intense focus on reform, "State of Health" explores these issues and more, bringing you stories of challenge and change in the Golden State. The blog is edited by Carrie Feibel.